Menopause, the Women’s Health Initiative, and Hormone Replacement Therapy

Every day 6,000 women enter menopause, the one-year mark without a period. A billion women on the planet are in the menopausal life stage, and for many, the transition can take a toll on health, relationships, and quality of life. But why is no one talking about it? 

An article in the New York Times published in February sparked conversations among women from the streets to our practice. Women are up in arms about the lack of compassionate care they’ve received from the healthcare system as they struggle with menopause. Doctors tend to brush off many symptoms as “a normal part of aging.” Still, a significant number of women don’t discuss menopausal symptoms with their doctor at all. 

As an integrative medicine and innovative gynecology practice, we believe in caring for the whole woman at all stages of life, including when she is beyond fertility. We offer an integrative approach utilizing tools from many modalities, including hormone therapy. 

Let’s dive into menopause, why hormones are so misunderstood, and why you have permission to contemplate if hormone therapy is right for you.  

What is Menopause? 

As mentioned, menopause is a somewhat arbitrary point in time, defined as one-year since the final menstrual period. 

When we talk about the struggles and discomforts of menopause, we are usually talking about perimenopause, the four to 10 years before menopause characterized by hormonal swings and the eventual decline of the ovarian hormones estrogen and progesterone. 

Perimenopausal symptoms include:

• Hot flashes
• Night sweats
• Mood swings
• Heavy periods
• Irregular menstrual cycles
• Weight gain
• Brain fog
• Vaginal dryness
• Reduced libido
• Joint aches

And the list goes on. Through perimenopause, menopause, and into post-menopause, low estrogen levels correlate with increased risk for depression, dementia, heart disease, osteoporosis, and other chronic diseases. Women may live longer, but after menopause, health can rapidly decline. 

It turns out that ovarian hormones provide ample protection to many body systems, including the immune, cardiovascular, musculoskeletal, gut-brain axis, and more. When women hit menopause, they lose some of this vital protection and disease risk goes up. The risks associated with hormone loss may differ for each woman, given her genetics, lifestyle, and other factors. 

The Women’s Health Initiative 

In 2002, findings from the Women’s Health Initiative (WHI) study reported the dangers of hormone replacement therapy, specifically an increased risk of breast cancer and stroke. The media coverage of the data was oversimplified and suggested alarming risk when risks were still low in context. 

Essentially women stopped taking hormone replacement therapy overnight. Over the last two decades, an entire generation of women haven’t had the option of estrogen replacement therapy. In addition, a generation of doctors weren’t trained in hormone replacement therapy and how to support women through perimenopause and beyond. 

In hindsight, there were a lot of problems with the WHI, including:

• The type of hormones administered (non-identical to human hormones)
• How the hormones were administered (oral vs. transdermal)
• The population of women selected (mostly in their 60s vs. 40s or 50s)
• The interpretation and delivery of the data

Reexaminations of WHI data and new data gathered over the last 20 years suggest that for many women, the benefits of hormone replacement therapy outweigh the risks. At the very least, hormone replacement should be an option to improve health and quality of life. 

Bioidentical Hormone Replacement Therapy

When it comes to hormone replacement therapy, we believe in bioidentical hormones, which are identical to the hormones naturally produced by your body. These hormones are different and much safer, than those used in the WHI study or those found in hormonal birth control options. Today, many FDA-prescription options are bioidentical. 

Hormone therapy isn’t for every woman, but it should at least be an option with informed consent. There needs to be a conversation with your healthcare provider about the benefits and risks of hormone therapy, considering your personal preference, the severity of symptoms, and medical history. 

One problem in today’s healthcare landscape is the challenge of having this needed conversation. Many doctors are not trained in hormone therapy and don’t have the time in a short office visit to give the topic the attention and nuance it requires. This is even true of many gynecologists, making it hard to know where to turn when you need help managing your hormones. 

At TaraMD, we offer whole women support during this unpredictable transition time. We take the time to listen, understand your symptoms and concerns, and develop a treatment plan that works best for you. With a foundation of nutrition and lifestyle change, we’ll layer in supportive treatments, including acupuncture, herbs and supplements, and bioidentical hormones when it’s a good fit. 

To learn more about perimenopause, its symptoms, and integrative approaches, please read How to Feel Better Through Perimenopause.

Please reach out if you are ready for more support and to feel better in your 40s, 50s, and beyond. We understand what you are going through and how to help with scientific evidence, kindness, and compassion. We promise your best years are still to come!